When I last visited Africa I had the privilege of visiting Kruger National Park. I indulged my love of photography and captured some great photographs of the magnificent countryside, good friends and elephants shaking marula trees. However, I recently came across photographs from Africa that have the potential to really make a difference for Africans. The photos were taken by a Faculty member at Queen’s, Dr. Karen Yeates. When Karen goes to Africa she takes her smart phone and the subject of the photography is remarkable: the human cervix!
Cervical cancer is one of the two most common causes of cancer in African women. Remarkably cervical cancer is caused by the human papilloma virus. There is now a vaccine for cervical cancer (Gardasil®), making this cancer almost entirely preventable. There is also a simple blood test to diagnose HPV. Of course both the test and the vaccine cost money and require vision and willpower to implement (even in Canada). Cervical cancer is also extremely easy to treat in its early stages. In resource rich countries, PAP smears and colposcopy (plus D&C) are used for early stage treatment. In resource-limited countries, like Tanzania, PAP smears have technical challenges (cost and expertise) that limit dissemination, especially to remote, rural areas. There is a long list of well-intentioned first world solutions to third world health issues that have failed (often because they are imposed from the outside and/or are nonsustainable). This story, which has a Queen’s connection, may be an example of a new strategy that uses simple technology to think globally while acting locally.
Dr. Yeates is a young nephrologist at Queen’s University. And how does this qualify her to deal with cervical cancer you might ask? Karen’s interest is in applying access to health in resource-limited areas through the use of simple technologies. During her time in Tanzania she encountered a talented local gynecologist, Dr. Olola Oneko, who has been applying the technique of cervicography to diagnose cervical cancer. This technique uses a camera to make an image of the cervix during a pelvic exam. The cervix is painted with acetic acid (vinegar) and the early changes of cancer are visible on the magnified photograph. Early cancerous lesions can then be treated with local freezing (or referred if the cancer is more advanced).
Drs. Yeates and Oneko took this idea to the next step. What if they used a smart phone to take the image-no need for expensive cameras, internet connections or repeat visits. Just train local health workers to do the pelvic exam, paint the cervix, take the photo and text it to Dr. Oneko or another specialist. An immediate text back says, “Normal, Please refer to a specialist or early disease-use local freezing (delivered by an inexpensive, portable freezing probe, at the same visit)”. How cool is that?Courtesy of a Rising Stars in Global Health grant, provided by Grand Challenges Canada, we will soon know whether this strategy works. This grant funds a pilot study, the Kilimanjaro Cervical Cancer Screening Project,that will allow Drs. Yeates and Oneko to determine efficacy and practicality of what sounds like a very sustainable intervention.
This project required not only the vision and commitment of the lead investigators but also some visionary leadership at home to provide protected time for researchers to take on challenges in Science and Medicine that impact Canadians and also more broadly benefit humanity. The support of Karen’s colleagues in Nephrology, including her boss, Dr. Ross Morton, has provided time for her to do this research. The vision of the Dean of Health Sciences, Dr. Richard Reznick, has created funding to support the development of Clinician- Scientists.
The aphorism (often attributed to Africa-but perhaps coined by the author Toni Morrison “It takes a Village”, also applies to the training and support of a new breed of doctor, the Clinician-Scientist. Hopefully this will prove effective and will later allow screening for HPV using a simple local test. I like this story because these characters in the story are linked by technology (a smart phone) but more importantly by a shared belief that we can make a difference.
Check out this interesting project.